SGN2017-00048 RECEIVED :
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MAY 0 9 2017
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COMMUNITY DEVO
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• - CITY OF TIGARD
Appli a
Temporary Sign Permit At1C WINNING/ENGINEERING
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SIGN LOCATION REQUIRED SUBMITTAL
Address: 12860 SW Pacific Hwy Suite #: ELEMENTS
Cin state: Tigard,OR Zip: 97223
/ g P Size information type and size
Tenant or business: Jiffy Lube dimensions
❑ Application Fee
Property owner: � ) ,j Property owner signature/
Address: 1(1)07 3 1 V C�!� ��,n � \Vim` ' written authorization
City/state: .0bri'Icin.d 1 d Zip: 6C7 NOTES:
Phone: Email: 0 Com,-C„-‹ Glo($144.041 • Applications will not be accepted
Contact name: 1-60 y 61 at-PPdbQ t.{ without all required submittal elements.
(V`� • Temporary Signs)8.'780.100
APPLICANT • Balloon Signs 18.780.100
Name: Doorknob Ventures LLC dba Jiffy Lube
Address: 1805 NE Sandy Blvd FOR STAFF USE ONLY
City/state: Portland,OR lip: 97232Case No.: )? _00046
Phone:(503)582-0505 Email: AP@doorknb.com
Contact name: P4 nn ; or fAA l l Approved and issued:
By: Date:
SIGN INFORMATION (Check all that apply) Permit fee: tei �+t 1
El Balloon Map/TL#: a�I�'RCEE al n Jv/ O
Install date: (Valid for Il)days)
Zoning: CL
❑ Lawn Sign (Including A-frames) CQ
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Total sign
Install date: (Valid for 31)days) 1ArA1RPUtVelanerslLana Use Apptioatipns Rev. 2/22/2016
l Banner
Install date: 05/05/2017 (Valid for 30 days)
❑ Other:
Sign dimensions: 8'X 3' Sign area: 24' (sci.ft.)
Materials: Vinyl
Direction wall faces(circle one411
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Ap iicant's ------- Print name Date }
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It):of Tigard-1—3 -5 S\X'Miall Blvd. • Tigard.Oregon 07223 • ww.utigard-or.gov • 503-718-2421 • Page 1 of 1
City ofTigard • COMMUNITY DEVELOPMENT DEPARTMENV 0
Request for Permit Action
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II —C/2-607 Ali'',
TIGARD, 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: I 1 Owner ❑ Applicant ❑ Contractor ® City Staff
Check(✓)one
REFUND OR Name: N/A
INVOICE TO: (Business or Individual)
Mailing Address: N/A
City/State/Zip: N/A
Phone No.: N/A
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
M 4 e . PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: SGN2017-00048
Site Address or Parcel #: 12860 SW Pacific Highway
Project Name: Jiffy Lube
Subdivision Name: N/A Lot#: N/A
EXPLANATION: Applicant never paid application fee, and now requests to void this permit.
//// Date: 5/10/17
Signature: �w_ --t- ;�iXe
Print Name: Lina Smith
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date Z !
6 /� By I •_
Refund Processed: Date /ll . By 1 Invoice Processed: Date By
Permit Canceled: Date 2_,if7 B c;•.r Parcel Tag Added: Date By
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I:\Building\Fos\RegPermitAction_ 231 .doc